Lygrisse Katherine A, Singh Vivek, Oakley Christian T, Tang Alex, Zak Stephen G, Clair Andrew J, Lajam Claudette M
Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA.
Arch Orthop Trauma Surg. 2023 Mar;143(3):1571-1578. doi: 10.1007/s00402-022-04415-3. Epub 2022 Mar 23.
Length of stay (LOS) and readmissions are quality metrics linked to physician payments and substantially impact the cost of care. This study aims to evaluate the effect of documented and undocumented psychiatric conditions on LOS, discharge location, and readmission following total knee arthroplasty (TKA).
Retrospective review of all primary, unilateral TKA from 2015 to 2020 at a high-volume, academic orthopedic hospital was conducted. Patients were separated into three cohorts: patients with a documented psychiatric diagnosis (+Dx), patients without a documented psychiatric diagnosis but with an actively prescribed psychiatric medication (-Dx), and patients without a psychiatric diagnosis or medication (control). Patient demographics, LOS, discharge location, and 90 days readmissions were assessed.
A total of 2935 patients were included; 1051 patients had no recorded psychiatric medications (control); 1884 patients took at least one psychiatric medication, of which 1161 (61.6%) were in the-Dx and 723 (38.4%) were in the +Dx cohort. Operative time (+Dx, 103.4 ± 29.1 and -Dx, 103.1 ± 28.5 vs. 93.6 ± 26.2 min, p < 0.001 for both comparisons) and hospital LOS stay (+ Dx, 3.00 ± 1.70 and -Dx, 3.01 ± 1.83 vs. 2.82 ± 1.40 days, p = 0.021 and p = 0.006, respectively) were greater for patients taking psychiatric medications when compared to the control group. Patients taking psychiatric medication with or without associated diagnosis were significantly more likely to be discharged to a secondary facility-22.8% and 20.9%, respectively-compared to controls, at 12.5% (p < 0.001). Ninety-day readmission rates did not differ between the control and both psychiatric groups (p = 0.693 and p = 0.432, respectively).
TKA patients taking psychiatric medications with or without a documented psychiatric diagnosis have increased hospital LOS and higher chances of discharge to a secondary facility. Most patients taking psychiatric medication also had no associated diagnosis. Payment models should consider the presence of undocumented psychiatric diagnoses when constructing metrics. Surgeons and institutions should also direct their attention to identifying, recording, and managing these patients to improve outcomes.
Retrospective Cohort Study.
住院时间（LOS）和再入院率是与医生薪酬相关的质量指标，对医疗成本有重大影响。本研究旨在评估已记录和未记录的精神疾病状况对全膝关节置换术（TKA）后住院时间、出院地点和再入院率的影响。
对一家大型学术骨科医院2015年至2020年所有初次单侧TKA进行回顾性研究。患者被分为三组：有精神疾病诊断记录的患者（+Dx）、无精神疾病诊断记录但正在积极服用精神科药物的患者（-Dx）和无精神疾病诊断或未服用精神科药物的患者（对照组）。评估患者的人口统计学特征、住院时间、出院地点和90天再入院率。
共纳入2935例患者；1051例患者未记录精神科药物（对照组）；1884例患者至少服用一种精神科药物，其中1161例（61.6%）属于-Dx组，723例（38.4%）属于+Dx组。与对照组相比，服用精神科药物的患者手术时间更长（+Dx组为103.4±29.1分钟，-Dx组为103.1±28.5分钟，对照组为93.6±26.2分钟，两组比较p均<0.001），住院时间也更长（+Dx组为3.00±1.70天，-Dx组为3.01±1.83天，对照组为2.82±1.40天，p分别为0.021和0.006）。与对照组的12.5%相比，服用精神科药物且有或无相关诊断的患者出院至二级医疗机构的可能性显著更高，分别为22.8%和20.9%（p<0.001）。对照组与两个精神疾病组的90天再入院率无差异（p分别为0.693和0.432）。
服用精神科药物且有或无精神疾病诊断记录的TKA患者住院时间延长，出院至二级医疗机构的可能性更高。大多数服用精神科药物的患者也没有相关诊断。支付模式在构建指标时应考虑未记录的精神疾病诊断情况。外科医生和医疗机构也应关注识别、记录和管理这些患者，以改善治疗效果。
回顾性队列研究。
